Manual Therapy, Posturology & Rehabilitation Journal
https://app.periodikos.com.br/journal/mtprehab/article/doi/10.17784/mtprehabjournal.2017.15.530
Manual Therapy, Posturology & Rehabilitation Journal
Research Article

Effects of Treadmill Training in chronic hemiparetic: a randomized, double-blind clinical trial

Gomes, Wildja de Lima; Dias, Luciara Irene de Nadai; Guimarães, Rachel Paes; Stivali, Cínthia Mara; Faria, Gisele da Rosa; Bovi, Ana Carolina Nunes; Cacho, Ênio Walker de Azevedo; Cacho, Roberta de Oliveira; Lima, Núbia Maria Freire Vieira

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Abstract

Background: It is estimated that the prevalence of cerebrovascular accident (CVA) increases significantly as a result of the increase in the elderly population, leading to dependence and care. Interventions with physical exercises are essential for patients with chronic CVA and hemiparesis to contribute to functional motor recovery. The gait of the hemiparetic patients is very impaired, including decreased speed, unipodal support in the abbreviated paretic limb, increased step length, decreased hip flexion, increased knee flexion and plantar flexion and involves compensatory strategies to deal with deficits of the affected limb. Rehabilitation programs of patients with CVA should focus on the restoration of the individual’s independence and ability to move. Objective: To analyze the effects of the addition of a load on a lower limb not affected in the discharge of weight and motor function of paretic lower limb. Method: Experimental, randomized, double-blind study conducted at the Physiotherapy and Occupational Therapy Outpatient Clinic of the Hospital das Clínicas (HC) - UNICAMP. Participants were assessed by the Confidence and Balance Scale, Fugl-Meyer Assessment of Physical Performance (FMA), Modified Ashworth Scale (MAS), Postural Stroke Scale for post-stroke patients (PSS), Time up and go test (TUG), 10-Meter gait test, Stroke Scale Barthel and weight transfer in the affected lower limb. Participants were treated in 12 walking training sessions on the treadmill with 1 kg added to the ankle of the lower limb. Results: There were variations between the 3 times for gait time (p= 0.005), FMA (p= 0.002), Activities-specific Balance Confidence Scale (ABC scale) (p= 0.007) and EAPA (p= 0.042). Conclusion: Treadmill therapy and weight addition in the healthy limb revealed improvement in motor function, balance in orthostatism and walking speed.

Keywords

Paresis; Stroke; Gait; Lower Extremity.

References

1. Roger V, Go A, Lloyd-Jones D, Adams R, Berry J, Brown T et al. Heart Disease and Stroke Statistics--2011 Update: A Report From the American Heart Association. Circulation. 2010;123(4):e18-e209.

2. Krebs H, Volpe B. Robotics: A Rehabilitation Modality. Current Physical Medicine and Rehabilitation Reports. 2015;3(4):243-247.

3. Michael K, Allen J, Macko R. Reduced Ambulatory Activity After Stroke: The Role of Balance, Gait, and Cardiovascular Fitness. Archives of Physical Medicine and Rehabilitation. 2005;86(8):1552-1556.

4. Ivey F. Task-oriented treadmill exercise training in chronic hemiparetic stroke. The Journal of Rehabilitation Research and Development. 2008;45(2):249-260.

5. Balasubramanian C, Neptune R, Kautz S. Variability in spatiotemporal step characteristics and its relationship to walking performance poststroke. Gait & Posture. 2009;29(3):408-414.

6. Fulk G, Reynolds C, Mondal S, Deutsch J. Predicting Home and Community Walking Activity in People With Stroke. Archives of Physical Medicine and Rehabilitation. 2010;91(10):1582-1586.

7. Harvey R. Improving poststroke recovery: Neuroplasticity and taskoriented training. Current Treatment Options in Cardiovascular Medicine. 2009;11(3):251-259.

8. McCain K, Pollo F, Baum B, Coleman S, Baker S, Smith P. Locomotor Treadmill Training With Partial Body-Weight Support Before Overground Gait in Adults With Acute Stroke: A Pilot Study. Archives of Physical Medicine and Rehabilitation. 2008;89(4):684-691.

9. Boake C, Noser E, Ro T, Baraniuk S, Gaber M, Johnson R et al. ConstraintInduced Movement Therapy During Early Stroke Rehabilitation. Neurorehabilitation and Neural Repair. 2007;21(1):14-24.

10. Ivar Gjellesvik T, Brurok B, Hoff J, Tørhaug T, Helgerud J. Effect of High Aerobic Intensity Interval Treadmill Walking in People With Chronic Stroke: A Pilot Study With One Year Follow-Up. 2017.

11. Lam J, Globas C, Cerny J, Hertler B, Uludag K, Forrester L et al. Predictors of Response to Treadmill Exercise in Stroke Survivors. Neurorehabilitation and Neural Repair. 2010;24(6):567-574.

12. Lam J, Globas C, Cerny J, Hertler B, Uludag K, Forrester L et al. Predictors of Response to Treadmill Exercise in Stroke Survivors. Neurorehabilitation and Neural Repair. 2010;24(6):567-574.

13. Haas B, Bergström E, Jamous A, Bennie A. The inter rater reliability of the original and of the modified Ashworth scale for the assessment of spasticity in patients with spinal cord injury. Spinal Cord. 1996;34(9):560-564.

14. Maki T, Quagliato E, Cacho E, Paz L, Nascimento N, Inoue M et al. Estudo de confiabilidade da aplicação da escala de Fugl-Meyer no Brasil. Revista Brasileira de Fisioterapia. 2006;10(2):177-183.

15. Ng S, Hui-Chan C. The Timed Up & Go Test: Its Reliability and Association With Lower-Limb Impairments and Locomotor Capacities in People With Chronic Stroke. Archives of Physical Medicine and Rehabilitation. 2005;86(8):1641-1647.

16. Yoneyama, SM; Roiz RM; Oliveira, MT; Oberg DT; Lima; NMVF. Validação da versão brasileira da escala de avaliação postural para pacientes após acidente vascular encefálico.” Acta fisiátrica 15.2 (2016): 96-100.

17. Collen F, Wade D, Bradshaw C. Mobility after stroke: Reliability of measures of impairment and disability. International Disability Studies. 1990;12(1):6-9.

18. Mahoney, F. I., & Barthel, D. W. Functional evaluation: The Barthel Index: A simple index of independence useful in scoring improvement in the rehabilitation of the chronically ill. Maryland State Medical Journal, 14, (1965) 61-65.

19. Branco, PS. Validação da Versão Portuguesa da Activities-specific Balance Confidence Scale. Revista da Sociedade Portuguesa de Medicina Física e de Reabilitação 19.2 (2010): 20-25.

20. Yen C, Wang R, Liao K, Huang C, Yang Y. Gait Training—Induced Change in Corticomotor Excitability in Patients With Chronic Stroke. Neurorehabilitation and Neural Repair. 2007;22(1):22-30.

21. Westlake K, Patten C. Pilot study of Lokomat versus manual-assisted treadmill training for locomotor recovery post-stroke. Journal of NeuroEngineering and Rehabilitation. 2009;6(1):18.

22. Middleton A, Merlo-Rains A, Peters D, Greene J, Blanck E, Moran R et al. Body Weight–Supported Treadmill Training Is No Better Than Overground Training for Individuals with Chronic Stroke: A Randomized Controlled Trial. Topics in Stroke Rehabilitation. 2014;21(6):462-476.

23. Franceschini M, Carda S, Agosti M, Antenucci R, Malgrati D, Cisari C. Walking After Stroke: What Does Treadmill Training With Body Weight Support Add to Overground Gait Training in Patients Early After Stroke?: A Single-Blind, Randomized, Controlled Trial. Stroke. 2009;40(9):3079-3085.

24. Balasubramanian C, Bowden M, Neptune R, Kautz S. Relationship Between Step Length Asymmetry and Walking Performance in Subjects With Chronic Hemiparesis. Archives of Physical Medicine and Rehabilitation. 2007;88(1):43-49.

25. Regnaux J, Pradon D, Roche N, Robertson J, Bussel B, Dobkin B. Effects of loading the unaffected limb for one session of locomotor training on laboratory measures of gait in stroke. Clinical Biomechanics. 2008;23(6):762-768.

26. Verheyden G, Vereeck L, Truijen S, Troch M, LaFosse C, Saeys W et al. Additional Exercises Improve Trunk Performance After Stroke: A Pilot Randomized Controlled Trial. Neurorehabilitation and Neural Repair. 2008;23(3):281-286.

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